Tech Stack

Description

You'll manage payment policy activities, resolve claims issues, and collaborate with teams to ensure accurate reimbursement. This role is essential to maintaining Oscar's claim infrastructure and regulatory compliance.

Requirements

• Bachelor's degree or 4+ years of commensurate experience.
• 4+ years in claims processing, coding, auditing, or healthcare operations.
• 4+ years of medical coding experience.
• Medical coding certification (CPC, COC, CCS, RHIT, RHIA).
• Experience with reimbursement methodologies, provider contracts, and claims processing.

Responsibilities

• Provide subject matter expertise on payment integrity claims edits and reimbursement policies.
• Analyze data to identify claims payment issues and define remediation steps.
• Examine industry standards to ensure alignment with policies and regulations.
• Respond to inquiries and disputes regarding policies and edits.
• Document coding rules and draft reimbursement policy recommendations.